Provider Demographics
NPI:1578219085
Name:ALBATROSS LICENSED BEHAVIOR ANALYSIS SERVICES PC
Entity type:Organization
Organization Name:ALBATROSS LICENSED BEHAVIOR ANALYSIS SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:REID
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:SPECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:913-909-9463
Mailing Address - Street 1:2715 TILDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-5019
Mailing Address - Country:US
Mailing Address - Phone:913-909-9463
Mailing Address - Fax:
Practice Address - Street 1:2715 TILDEN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-5019
Practice Address - Country:US
Practice Address - Phone:913-909-9463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health